Variability in Antibiotic Use Across PICUs*

Brogan, Thomas V.; Thurm, Cary; Hersh, Adam L.; Gerber, Jeffrey S.; Smith, Michael J.; Shah, Samir S.; Courter, Joshua; Patel, Sameer; Parker, Sarah K.; Kronman, Matthew P.; Lee, Brian; Newland, Jason G.

doi:10.1097/pcc.0000000000001535

Cited by 39 publications

(35 citation statements)

References 27 publications

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“…49 Critical care physicians acknowledge that the problem of antimicrobial resistance is relevant to their daily practice and that optimization of antibiotic prescribing behaviors should be a significant priority. 49,50 Intensivists must concurrently balance these concerns with the recognized need for prompt antibiotic initiation for pediatric sepsis and while bearing in mind that approximately one-half of all ICU patients are diagnosed with bacterial infections. [51][52][53] Major ASP challenges in PICU settings include widespread variability regarding use of available diagnostic testing methods and the relative ambiguity with interpretation of results.…”

Section: Hospitalistsmentioning

confidence: 99%

<p>Pediatric Antimicrobial Stewardship Programs: Current Perspectives</p>

Klatte

2020

PHMT

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With the rapid growth of the field of pediatric antimicrobial stewardship, there has been a marked increase in the establishment of programs dedicated to this specialty. Shared objectives of all pediatric antimicrobial stewardship programs (ASPs) include optimization of antibiotic use and improvement in clinical outcomes for children, while certain core operational strategies and metrics used to measure program effectiveness are typically utilized by pediatric ASPs. Antimicrobial stewardship is the responsibility of every individual who prescribes, dispenses, and administers antibiotics to children, and pediatric ASP principles are rooted in collaboration and cooperation. Pediatric ASPs are uniquely suited to meet the needs of the local populations they serve and the environments within which they practice while also fostering an awareness of the interconnected global nature of pediatric stewardship. As such, pediatric ASPs are well positioned to confront the evolving challenges of antimicrobial overuse and resistance.

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Section: Hospitalistsmentioning

confidence: 99%

<p>Pediatric Antimicrobial Stewardship Programs: Current Perspectives</p>

Klatte

2020

PHMT

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“…This difference may be attributable to seasonal variation because prescription rates increased during winter months in our study period [31]. The current antibiotic consumption places in our center are at the higher end of the ranges reported in Switzerland, Canada and the USA, where 550, 750 and 1000 DOTs per 1000 patient-days, respectively, have been reported [2,4,32].…”

Section: Discussionmentioning

confidence: 69%

“…Antibiotics are the most common medication prescribed in pediatric intensive care units (PICUs), with up to 50-100% of patients receiving an antibiotic prescription [1][2][3][4][5]. This may be due in part to a high prevalence of community-and hospital-acquired infections in these settings and an overall high risk of morbidity and mortality [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Evaluating antimicrobial appropriateness in a tertiary care pediatric ICU in Saudi Arabia: A retrospective cohort study

Kazzaz

AlTurki²,

Aleisa³

et al. 2020

Preprint

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Background: Inappropriate antibiotic utilization is associated with the emergence of antimicrobial resistance (AMR) and a decline in antibiotic susceptibility in many pathogenic organisms isolated in intensive care units. Antibiotic stewardship programs (ASPs) have been recommended as a strategy to reduce and delay the impact of AMR. A crucial step in ASPs is understanding antibiotic utilization practices and quantifying the problem of inappropriate antibiotic use to support a targeted solution. We aim to characterize antibiotic utilization and determine the appropriateness of antibiotic prescription in a tertiary care pediatric intensive care unit.Methods: A retrospective cohort study was conducted at King Abdullah Specialized Children’s Hospital (KASCH), Riyadh, Saudi Arabia, over a 6-month period. Days of therapy (DOT) and DOT per 1000 patient-days were used as measures of antibiotic consumption. The appropriateness of antibiotic use was assessed by two independent pediatric infectious disease physicians based on the Centers for Disease Control and Prevention 12-step Campaign to Prevent Antimicrobial Resistance Among Hospitalized Children.Results: During the study period, 497 patients were admitted to the PICU, accounting for 3009 patient-days. A total of 274 antibiotic courses were administered over 2553 antibiotic days. Forty-eight percent of antibiotic courses were found to be nonadherent to at least 1 CDC step. The top reasons were inappropriate antibiotic choice (empirical or definitive) and inappropriate prophylaxis durations. Cefazolin and vancomycin contributed to the highest percentage of inappropriate DOTs.Conclusions: Antibiotic consumption was high with significant inappropriate utilization. These data could inform decision-making in antimicrobial stewardship programs and strategies. The CDC steps provide a more objective tool and limit biases when assessing antibiotic appropriateness

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Section: Discussionmentioning

confidence: 78%

Evaluating antimicrobial appropriateness in a tertiary care pediatric ICU in Saudi Arabia: A retrospective cohort study

Kazzaz

AlTurki²,

Aleisa³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Two-thirds of antibiotic prescriptions administered in pediatric inpatient care are inappropriate. This inappropriate utilization is associated with the emergence of antimicrobial resistance (AMR) and a decline in antibiotic susceptibility in many pathogenic organisms isolated in intensive care units. Antibiotic stewardship programs (ASPs) have been recommended as a strategy to reduce and delay the impact of AMR. A crucial step in ASPs is understanding antibiotic utilization practices and quantifying the problem of inappropriate antibiotic use to support a targeted solution. We aim to characterize antibiotic utilization and determine the appropriateness of antibiotic prescription in a tertiary care pediatric intensive care unit in Saudi Arabia.Methods A retrospective cohort study was conducted at King Abdullah Specialized Children’s Hospital (KASCH), Riyadh, Saudi Arabia, over a 6-month period. Days of therapy (DOT) and DOT per 1000 patient-days were used as measures of antibiotic consumption. The appropriateness of antibiotic use was assessed by two independent pediatric infectious disease physicians based on the guidelines of the Centers for Disease Control (CDC) 12-step campaign to prevent antimicrobial resistance among hospitalized children.Results During the study period, 497 patients were admitted to the PICU, accounting for 3009 patient-days. A total of 274 antibiotic courses were administered over 2553 antibiotic days. Ceftriaxone, vancomycin, ceftazidime, and cefazolin were responsible for the highest rates of consumption (164.8, 150.5, 91.7, and 83.1 DOTs per 1000 patient-days, respectively). Forty-eight percent of antibiotic courses were found to be nonadherent to at least 1 CDC step. The top reasons were inappropriate antibiotic choice (empirically or definitive) (31.3%) and inappropriate prophylaxis (30.2%). Infectious disease service consultation decreased the likelihood of inappropriate consumption of antibiotics.Conclusions Antibiotic consumption was high in our setting, with significant inappropriate utilization mainly due to empiric choices and the duration of prophylaxis. These data could inform decision-making in antimicrobial stewardship programs and strategies. The CDC steps provide a more objective tool and limit biases when assessing antibiotic appropriateness.

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Variability in Antibiotic Use Across PICUs*

Abstract: The wide variation in antibiotic use observed across children's hospital PICUs suggests inappropriate antibiotic use.

Cited by 39 publications

References 27 publications

<p>Pediatric Antimicrobial Stewardship Programs: Current Perspectives</p>

<p>Pediatric Antimicrobial Stewardship Programs: Current Perspectives</p>

Evaluating antimicrobial appropriateness in a tertiary care pediatric ICU in Saudi Arabia: A retrospective cohort study

Evaluating antimicrobial appropriateness in a tertiary care pediatric ICU in Saudi Arabia: A retrospective cohort study

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